The J-Curve Phenomenon in Hypertension

Abstract

Almost immediately after antihypertensive therapy was proven effective in preventing cardiovascular events, the J-curve issue emerged as a hot topic. The Hypertension Optimal Treatment (HOT) trial attempted to address this question (diastolic blood pressure <80, <85, and <90 mm Hg) but ended up with a post hoc analysis indicating a nadir of 138.5 mm Hg systolic and 82.6 mm Hg diastolic blood pressure. Nevertheless, this observational finding was supported by the results of observational studies in the general population and by post hoc analyses of antihypertensive treatment trials. The currently ongoing Systolic Hypertension Optimal Treatment (SHOT) trial investigates whether the relationship between systolic blood pressure and stroke recurrence is linear or J-shaped by treating systolic blood pressure to <125, <135, and <145 mm Hg in patients with a history of recent stroke. This trial may provide additional but probably inconclusive evidence, because optimal blood pressure might differ between individuals and across outcomes. Nevertheless, a universal beneficial, instead of optimal, level of blood pressure for antihypertensive treatment may exist approximating 130/80 mm Hg and should be investigated by comparing 130/80 mm Hg with 140/90 mm Hg as a target blood pressure in hypertensive patients with the simultaneous use of modern blood pressure measuring techniques, such as home and ambulatory blood pressure monitoring.

A Population Perspective on Prevention of Dementia

“…The association between blood pressure during late-life and dementia is suggested to follow a U- or J-shaped curve, with both high and low values imposing increased dementia risk [64]. This is consistent with ample research on the relationship between blood pressure and cardiovascular disease [65]. With regard to BMI, a similar J-shaped relation with dementia risk is suggested in late-life, with elevated BMI levels being associated with lower, and being underweight with increased, dementia risk [66], suggesting a similar type of J-shaped curve as with blood pressure.…”

Universal Coverage of Hypertension Treatment Services in Malaysia Is Still an Elusive Goal

“…21 However, the question of whether there exists a DBP threshold below which risks of adverse events increases (the blood pressure Jcurve) has yet to be conclusively answered. 22,23 In general practice, medical practitioners provide treatment with an aim to reduce blood pressures below target blood pressure levels. These targets vary according to the patient's cardiovascular risk factors and have changed over time in line with available evidence advocating higher or lower blood pressures for persons with different cardiovascular risk factors.…”

Primary prevention of cardiovascular disease: Updated review of contemporary guidance and literature

“…In terms of target BPs there has been a suggestion of a J-shaped curve in CVD events from observational trials 65,79,80 but there are significant concerns over confounding variables and no clear data supporting this from RCTs. 81 Physiologically there must be a suboptimal arterial pressure at which systemic perfusion becomes compromised but this level remains unsatisfactorily delineated. Meta-analysis suggests that more aggressive SBP and DBP lowering leads to further reduction in CVD events, 82 whilst current target levels are largely based upon evidence from the SPRINT trial which demonstrated an increased rate of hypotensive side-effects when intensive SBP targets of <120 were set in comparison to <140.…”